The Centers for Medicare and Medicaid Services (CMS) has updated their survey and certification guidelines for outpatient rehabilitation facilities (i.e. Rehab Agencies). CMS released transmittal

The Medicare Payment Advisory Commission (MedPAC) renewed its calls to reform the Medicare physician payment system in its annual report to Congress on Medicare payment policy issued March 15 and in congressional testimony given the same day. To read the report, click HERE.  

On March 14, 2013, Representatives Joe Courtney and Tom Latham introduced H.R. 1179 that would count a period of receipt of outpatient observation services in a hospital toward satisfying the 3-day inpatient hospital requirement for coverage of skilled nursing facility services under Medicare. Currently patients under observation status at a hospital do not qualify as meeting the required three days for coverage in the SNF setting. This legislation would insure patients have access to their SNF benefits when being hospitalized. To read the full text of the bill, click HERE.

On March 21, 2013, Representative Tom Price (R-GA) introduced the Medicare Patient Empowerment Act of 2013 (HR 1310), which would provide physical therapists and other providers with the ability to privately contract with Medicare beneficiaries. To read the full text of the bill, click HERE.

A redetermination is an independent review of an initial claim determination performed by the same contractor that processed the original claim. This independent review is performed by staff not involved with making the original claim determination. A request for a redetermination must be submitted in writing and should be made on the standard Centers for Medicare & Medicaid (CMS)

On March 21, 2013, the Centers for Medicare and Medicaid Services (CMS) released additional guidance on manual medical review for outpatient therapy services exceeding $3,700 in calendar year 2013. This applies to all Part B outpatient therapy settings except critical access hospitals. Medicare Administrative Contractors (MACs) will conduct prepayment review on claims reaching the $3,700 threshold with dates of service January 1, 2013 to March 31, 2013.  CMS requested MACs conduct these manual medical reviews within 10 days. At this time, there is no advance request for an exception process. Effective April 1, 2013, the Recovery Auditors will conduct review

National Government Services (NGS) has been awarded the Jurisdiction 6 A/B MAC contract for the administration of Medicare fee-for-service claims in 3 states as well as processing Medicare Home Health plus Hospice billings in 13 states and 5 U.S. territories. The 3 Medicare fee-for-service claims states are

Noridian Administrative Services (NAS) has been awarded the Jurisdiction E A/B MAC contract for the administration of the Part A and Part B Medicare fee-for-service claims in the states and territories of